转化生长因子-β2体外诱导骨髓间充质干细胞表达软骨细胞表型的观察

目的观察骨髓间充质干细胞(MSCs)在转化生长因子(TGF-β2)诱导下向软骨细胞表型转化的能力,探讨其作为软骨组织工程种子细胞的可能性。方法抽取兔髂骨骨髓液3～4ml,进行原代和传代培养,传代后实验组以高糖DMEM无血清特定培养液诱导,培养液含TGF-β210ng/ml、地塞米松10-7mol/L、维生素C50μmol/L;对照组以高糖DMEM无血清培养液培养,相差显微镜下观察细胞形态变化,免疫组织化学染色检测软骨特异性Ⅱ型胶原表达。结果诱导后细胞体外扩增能力显著降低,细胞形态由成纤维样梭形向多角形、多边形或类圆形转变,诱导21d后细胞形态变化最为显著,Ⅱ型胶原免疫组织化学染色深而均匀。结论TGF-β2可有效诱导MSCs向软骨细胞表型转化,分泌软骨细胞特异性基质,有可能成为软骨组织工程较理想的种子细胞来源。     

TGF-β2体外诱导骨髓间充质干细胞表达软骨细胞表型的观察

目的：观察骨髓间充质干细胞（MSCs）在TGF-β2诱导下向软骨细胞表型转化的能力,探讨其作为软骨组织工程种子细胞的可能性。方法：抽取兔髂骨骨髓液3-4ml,进行原代和传代培养,传代后实验组以高糖DMEM无血清特定培养液诱导f含TGF-β2 10ng／ml、地塞米松10^-7M、维生素C50μmol／L）,对照组以高糖DMEM无血清培养液培养,相差显微镜下观察细胞形态变化,免疫组织化学染色检测软骨特异性Ⅱ型胶原表达。结果：诱导后细胞体外扩增能力显著降低,细胞形态由成纤维样梭形向多角形、多边形或类圆形转变,诱导21天后细胞形态变化最为显著,Ⅱ型胶原免疫组化染色深而均匀。结论：TGF-β2可有效诱导MSCs向软骨细胞表型转化,分泌软骨细胞特异性基质,有可能成为软骨组织工程较理想的种子细胞来源。     

鹿茸多肽对兔骨髓间质干细胞体外软骨表型诱导分化的影响

目的:通过对体外培养的兔骨髓间质干细胞(MSCs)在特定培养液作用下向软骨细胞表型分化的研究,探讨鹿茸多肽对其软骨分化的影响。方法:将第3代兔MSCs随机分为A组(空白对照组)、B组(诱导组)、C组(鹿茸多肽组),并取兔的关节软骨作为D组(关节软骨组)。A、B、C 3组分别采用普通培养液、诱导培养液、含10 ug/m l鹿茸多肽的诱导培养液于离心管内进行培养,分别于1、2、3周后取材,通过组织学、生物化学和RT-PCR技术,对离心管内构建的软骨组织进行形态学和细胞功能状态的观察。结果:A组培养2周后,细胞团块逐渐崩解,无法进行HE染色。B、C组细胞团块除有轻度收缩外,呈白色半透明状,HE染色发现细胞为圆形或卵圆形,表层细胞密度大。B、C组糖胺多糖(GAG)含量及Ⅱ型胶原mRNA表达随培养时间延长而增多,并以C组为著;各时间点B、C组与A组相比明显增多,且差异有显著性统计学意义(P<0.01),C组与B组相比较多,差异有显著性统计学意义(P<0.01),C组与D组相比较少,差异有显著性统计学意义(P<0.01)。结论:MSCs在特定培养条件下能向软骨细胞表型分化,且鹿茸多肽对其定向软骨分化有明显促进作用。虽然在体外可以构建出软骨组织,但其与关节软骨质量相比仍有很大差距。     

骨髓基质细胞与关节软骨细胞生物学特性的比较研究

目的观察兔骨髓基质细胞(MSCs)诱导和基因修饰后的主要生物学特性,并与关节软骨细胞进行比较. 方法抽取成年雄性新西兰大白兔髂骨骨髓,密度梯度离心获得骨髓基质细胞,培养传至第5代,按处理方法分为常规培养液组(A组)、条件培养液组(B组)及重组缺陷型腺病毒携带肝细胞生长因子cDNA转染组(C组).条件培养液为常规培养液中含转化生长因子-β1(10 ng/ml)、碱性成纤维细胞生长因子(25 ng/ml)和地塞米松(10-7 mol/L).切取兔膝关节软骨,3 mg/ml Ⅱ型胶原酶消化传代培养至第3代(D组).观察原代MSCs及第5代MSCs(体外培养8～10周后)细胞形态,对第5代MSCs及第3代软骨细胞进行Ⅰ、Ⅱ型胶原免疫组织化学染色,MTT法检测细胞增殖情况.阿利新蓝法检测细胞培养上清液中糖胺多糖(GAG)含量.提取各组培养细胞总RNA,RT-PCR检测Ⅰ、Ⅱ型胶原表达. 结果原代MSCs为短梭形、簇状生长,传代细胞呈长梭形、旋涡样生长.A组细胞爬片Ⅰ型胶原免疫组织化学染色阳性,Ⅱ型胶原免疫组织化学染色阴性,GAG含量低,与D组比较,差异有统计学意义(P＜0.05).B组细胞爬片Ⅰ、Ⅱ型胶原免疫组织化学染色阳性,GAG含量升高,与D组比较差异无统计学意义(P＞0.05);C组转染后第4天增殖率降低,与A组比较差异有统计学意义(P＜0.05),其余时间点各组间无统计学意义(P＞0.05).RT-PCR表明A、B、C组均表达Ⅰ型胶原,B、D组可表达Ⅱ型胶原,C组有较弱的Ⅱ型胶原表达. 结论 MSCs体外培养过程中自然转归趋向于成骨.传代后经向成软骨方向诱导,具有向软骨分化的能力;体外传代培养的MSCs具有干细胞自我增殖和定向分化的特性,可作为靶细胞接受外源目的基因转染并能有效表达.     

骨髓间质干细胞体外定向诱导分化为软骨细胞的实验研究

目的：探讨分离骨髓间充质干细胞（MSCs）并诱导其向软骨细胞转化的体外培养方法,为软骨组织工程的种子细胞来源提供实验依据。方法：抽取兔髂骨骨髓液,经梯度离心法和贴壁法进行体外培养,贴壁细胞传代,取第3代细胞在培养基中添加软骨分化诱导剂[含转化生长因子（TGF-β2）10ng／ml、地塞米松10^7mol／L、维生素C50μmol／L,经7、14、21d诱导培养后,倒置显微镜观察细胞形态,免疫组织化学染色检测软骨特异性Ⅱ型胶原表达。将诱导细胞与软骨支架材料-聚磷酸钙纤维／左旋聚乳酸（CPP／PLLA）复合,1周后终止培养,扫描电镜观察细胞黏附情况。结果：诱导后细胞体外扩增能力显著降低,细胞形态由成纤维样梭形向多角形、多边形或类圆形转变,诱导21d后细胞形态变化最为显著,Ⅱ型胶原免疫组化染色深而均匀。诱导后的MSCs可在支架材料内良好黏附生长。结论：体外培养的MSCs可定向诱导分化为软骨细胞,分泌软骨细胞特异性基质,可用作软骨组织工程的种子细胞。     

骨髓间质干细胞体外定向诱导分化为软骨细胞的实验研究

目的:探讨分离骨髓间充质干细胞(MSCs)并诱导其向软骨细胞转化的体外培养方法,为软骨组织工程的种子细胞来源提供实验依据.方法:抽取兔髂骨骨髓液,经梯度离心法和贴壁法进行体外培养,贴壁细胞传代,取第3代细胞在培养基中添加软骨分化诱导剂[转化生长因子(TGF-β2)10ng/ml、地塞米松10-7mol/L、维生素C 50μmol/L],经7、14、21 d诱导培养后,倒置显微镜观察细胞形态,免疫组织化学染色检测软骨特异性Ⅱ型胶原表达.将诱导细胞与软骨支架材料--聚磷酸钙纤维/左旋聚乳酸(CPP/PLLA)复合,1周后终止培养,扫描电镜观察细胞黏附情况.结果:诱导后细胞体外扩增能力显著降低,细胞形态由成纤维样梭形向多角形、多边形或类圆形转变,诱导21 d后细胞形态变化最为显著,Ⅱ型胶原免疫组化染色深而均匀.诱导后的MSCs可在支架材料内良好黏附生长.结论:体外培养的MSCs可定向诱导分化为软骨细胞,分泌软骨细胞特异性基质,可用作软骨组织工程的种子细胞.     

聚磷酸钙纤维／左旋聚乳酸软骨支架复合自体骨髓间充质干细胞构建组织工程化人工关节软骨

目的：应用组织工程学技术,体外初步构建组织工程化人工关节软骨。方法：制备三维多孔软骨支架材料CPP／PLLA,体外诱导兔MSCs向软骨细胞表型分化,免疫组织化学染色检测软骨特异性Ⅱ型胶原表达,将诱导细胞与软骨支架材料CPP／PLLA复合,体外培养构建人工关节软骨,1周后终止培养,扫描电镜观察组织工程化人工软骨的微观结构;同时将构建人工软骨移植于兔大腿皮下,3周后处死动物,甲苯胺蓝染色观察。结果：扫描电镜观察可见该复合材料CPP／PLLA为高孔隙率的网状、连通、微孔结构,微孔分布均匀,孔径大小为300～400μm之间;兔MSCs经体外软骨表型定向诱导后,Ⅱ型胶原免疫组化染色阳性。诱导后的MSCs可在支架材料内良好贴附生长,细胞被分泌的胶原基质包裹;从体内获取的培养物组织切片观察可见大量的软骨细胞生成,甲苯胺蓝染色阳性。结论：经软骨起源诱导后的MSCs与CPP／PLLA复合培养可以构建自体软骨移植的替代物,为应用软骨组织工程方法修复关节软骨缺损和功能重建提供一种新材料,具有较大的潜在应用价值。     

骨髓间充质干细胞体外定向软骨细胞分化的研究

目的　研究体外培养的兔骨髓间充质干细胞在特定培养条件下定向软骨细胞分化的情况。方法　取兔髂骨骨髓 ,分离培养骨髓间充质干细胞 ,传代后以高糖DMEM无血清特定培养诱导 (转化生长因子 β1 2 0ug L ,地塞米松10 7mmol L ,维生素C 5 0ug L) ,细胞 爬片甲苯胺蓝染色检测蛋白多糖 ,免疫细胞化学染色法检测Ⅱ胶原 ,S 10 0蛋白分泌 ,常规培养的细胞作为对照组。结果　骨髓间充质干细胞经特定培养条件诱导第 14 ,2 1,2 8天甲苯胺蓝染色呈明显异染 ,Ⅱ胶原 ,S 10 0蛋白免疫细胞化学染色阳性 ,第 7天及对照组阴性。结论　骨髓间充质干细胞是骨髓来源的具有多向分化潜能的干细胞 ,在体外培养可定向分化为软骨细胞 ,并能分泌软骨特异性基质。     

聚磷酸钙纤维和左旋聚乳酸软骨支架复合自体骨髓间充质干细胞构建组织工程化人工关节软骨

目的应用组织工程学技术，体外初步构建组织工程化人工关节软骨。方法制备三维多孔软骨支架材料CPP／PLLA，体外诱导兔MSCs向软骨细胞表型分化，免疫组织化学染色检测软骨特异性Ⅱ型胶原表达，将诱导细胞与软骨支架材料CPP／PLLA复合，体外培养构建人工关节软骨，1周后终止培养，扫描电镜观察组织工程化人工软骨的微观结构；同时将构建人工软骨移植于兔大腿皮下，3周后处死动物，甲苯胺蓝染色观察。结果扫描电镜观察可见该复合材料CPP／PLLA为高孔隙率的网状、连通、微孔结构，微孔分布均匀，孔径大小为300～400Ⅳn之间；兔MSCs经体外软骨表型定向诱导后，Ⅱ型胶原免疫组化染色阳性。诱导后的MSCs可在支架材料内良好贴附生长，细胞被分泌的胶原基质包裹；从体内获取的培养物组织切片观察可见大量的软骨细胞生成，甲苯胺蓝染色阳性。结论经软骨起源诱导后的MSCs与CPP／PLLA复合培养可以构建自体软骨移植的替代物，为应用软骨组织工程方法修复关节软骨缺损和功能重建提供一种新材料，具有较大的潜在应用价值。     

转化生长因子β1缓释载体诱导骨髓基质干细胞成软骨分化

目的探讨转化生长因子β1（TGF—β1）缓释对骨髓基质干细胞诱导成软骨分化的影响。方法乳化交联法制备TGF—β1壳聚糖缓释微球并将其与壳聚糖支架复合，将骨髓基质干细胞置于复合载体中立体培养，通过HE染色、Ⅱ型胶原免疫组化染色、扫描电镜观察复合载体对细胞的增殖、分化及功能的影响。结果骨髓基质干细胞于复合载体中培养，细胞形态类似软骨细胞，并可见细胞增殖及细胞外基质分泌，Ⅱ型胶原免疫组织化学染色示基质中有Ⅱ型胶原表达，其细胞增殖率及Ⅱ型胶原分泌功能均较对照组明显增强。结论复合载体能够控制TGF-β1的释放并保持其活性，可促进骨髓基质干细胞的增殖并诱导其向软骨细胞分化。     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.     

Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: A randomised, double-blind, cross-over study with and without adrenaline

Background: Basic pharmacological research indicates that there are synergistic antinociceptive effects at the spinal cord level between adrenaline, fentanyl and bupivacaine. Our clinical experience with such a mixture in a thoracic epidural infusion after major surgery confirms this. The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief and side effects when removing adrenaline from this triple epidural mixture. Methods: A prospective, randomised, double-blind, cross-over study was carried out in 24 patients after major thoracic or abdominal surgery. Patients with only mild pain when coughing during a titrated thoracic epidural infusion of about 10 ml · h^?1 of bupivacaine 1 mg · ml^?1, fentanyl 2 μg · ml^?1, and adrenaline 2 μg · ml^?1 were included. On the 1^st and 2^nd postoperative days each patient was given a double-blind epidural infusion, at the same rate, with or without adrenaline. The effect was observed for 4 h or until pain when coughing became unacceptable in spite of a rescue analgesic procedure. Rescue analgesia consisted of up to two epidural bolus injections per hour and i.v. morphine if necessary. All patients received rectal paracetamol 1 g, every 8 h. Fentanyl serum concentrations were measured with a radioimmunoassay technique at the start and end of each study period. Main outcome measures were extent of sensory blockade and pain intensity at rest and when coughing, evaluated by a visual analogue scale, a verbal categorical rating scale, the Prince Henry Hospital pain score, and an overall quality of pain relief score. Results: The number of hypaesthetic dermatomal segments decreased (P <0.001) and pain intensity at rest and when coughing increased (P <0.001) when adrenaline was omitted from the triple epidural mixture. This change started within the first hour after removing adrenaline. After 3 h pain intensity when coughing had increased to unacceptable levels in spite of rescue analgesia (epidural bolus injections and i.v. morphine). Within 15–20 min after restarting the triple epidural mixture with adrenaline, pain intensity was again reduced to mild pain when coughing. Serum concentration of fentanyl doubled from 0.22 to 0.45 ng · ml^?1 (P <0.01), and there was more sedation during the period without adrenaline. Conclusions: Adrenaline increases sensory block and improves the pain-relieving effect of a mixture of bupivacaine and fentanyl infused epidurally at a thoracic level after major thoracic or abdominal surgery. Serum fentanyl concentrations doubled and sedation increased when adrenaline was removed from the epidural infusion, indicating more rapid vascular absorption and systemic effects of fentanyl.     

Utilisation des médicaments prokinétiques en réanimation : indications et limites ?

Enteral feeding is often limited by gastric and intestinal motility disturbances in critically ill patients, particularly in patients with shock. So, promotility agents are frequently used to improve tolerance to enteral nutrition. This review summaries the pathophysiology, presents the available pharmacological strategies, the clinical data, the counter-indications and the principal limits. The clinical data are poor. No study demonstrates a positive effect on clinical outcomes. Metoclopramide and erythromycin seems to be the more effective. Considering the risk of antibiotic resistance, the first line use of erythromycin should be avoided in favor of metoclopramide.     

Anesthésie générale chez l’enfant : quid des pratiques en 2010 ?

Introduction

The practice of pediatric anesthesia requires a regular update of scientific knowledge and technical skills. To provide the most adequate Continuing Medical Education programs, it is necessary to assess the practices of pediatric anesthesiologists. Thus, the objective of this survey was to draw a picture of the current clinical practices of general anesthesia in children, in France.

Material and methods

One thousand one hundred and fifty questionnaires were given to anesthesiologists involved in pediatric cases. These questionnaires collected information on various aspects of clinical practice relative to induction, maintenance, recovery from general anaesthesia and also classical debated points such as children with Upper Respiratory Infection (URI), emergence agitation, epileptoid signs or anaesthetic management of adenoidectomy. Differences in practices between CHG (general hospital), CHU (teaching hospital), LIBERAL (private) and PSPH (semi-private) hospitals were investigated.

Results

There were 1025 questionnaires completed. Fifty-five percent of responders worked in public hospitals (CHG and CHU); 77% had a practice that was 25% or less of pediatric cases. In children from 3 to 10 years: 72% of respondents used always premedication and two thirds performed inhalation induction in more than 50% of cases. For induction, 53% used sevoflurane (SEVO) at 7 or 8%. Respondents from LIBERAL used higher SEVO concentrations. Tracheal intubation was performed with SEVO alone (37%), SEVO and propofol (55%) and SEVO with myorelaxant (8%), 93% of respondents used a bolus of opioid. For maintenance, the majority of respondents used SEVO associated with sufentanil; desflurane and remifentanil were more frequently used in CHU. Two thirds of respondents used N₂O. Depth of anesthesia was commonly assessed by hemodynamic changes (52%), end tidal concentration of halogenated (38%) or automated devices based on EEG (7%). In children with URI, 98% of respondents used SEVO for anesthesia. To control the airway 42% used a tracheal tube, 30% a laryngeal mask and 20% a facial mask. Emergence agitation was an important concern for two thirds of respondents, while epileptoid signs were considered as important by only 20%. Eighty-nine percent of respondents practiced anesthesia for adenoidectomy. Anesthesia was induced by inhalation of SEVO 7–8% (41%), 6% (39%) or 4% (12%), 66% put an intravenous line (less frequently in LIBERAL). 67% of the responders managed adenoidectomy without any device to control the airway (more frequently in LIBERAL), 32% administrated a bolus of opioid (less frequently in LIBERAL).

Discussion

This survey demonstrated that the practices regarding general anesthesia in children are relatively homogenous. Most of the differences appeared between LIBERAL and the others structures; the anaesthetic management for adenoidectomy illustrates these findings.     

Intérêt d’une rééducation précoce pour les patients neurologiques

Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients’ impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.     

Risiko Schlaganfall — Öffentlichkeitsarbeit und Aufklärung dringend erforderlich

Zusammenfassung Das wesentliche — und zugleich noch wenig ausgeschöpfte — Potenzial der Schlaganfallmedizin liegt in der langfristigen Prophylaxe. Durch Beeinflussung von Lifestylefaktoren wie Ernährungsgewohnheiten, Zigarettenkonsum und körperlichem Training durch entsprechende Aufklärung ließe sich ein erheblicher Teil an zerebralen Ereignissen vermeiden. Ein weiterer in Deutschland noch zu wenig beachteter Faktor ist die konsequente Blutdruckeinstellung. Breitgestreute Aufklärung könnte außerdem potenziellen Patienten helfen, bereits auftretende Warnsymptome wie die transiente ischämische Attacke richtig einzuschätzen, um eine rechtzeitige Behandlung zu ermöglichen.